The American journal of emergency medicine
-
As emergency medicine comes of age, it is interesting to examine the scientific nature of the specialty as reflected in the literature. Representative volumes of three emergency medicine journals were reviewed for number and type of article, institutional origin, article length, and number of authors. For Annals of Emergency Medicine, (AEM) volumes for 1975, 1980, and 1985 were studied. ⋯ However, there are increasing numbers of papers with multiple authors. Listing of multiple authors on papers has prompted criticism of the literature in other medical specialties. If this trend continues, there may be a risk of compromising the integrity of the published research.
-
Vagal maneuvers terminate new onset, catheter-induced paroxysmal supraventricular tachycardia (PSVT) in up to 92% of patients. The risk and benefit of vagal maneuvers for treating PSVT in the emergency department (ED) is inadequately defined. The purpose of this study was to determine the efficacy of nonpharmacological vagal interventions in converting spontaneous episodes of PSVT in adult patients and to derive a treatment plan for such patients based on clinical decision analysis. ⋯ The remainder received verapamil, which converted 12 of the 14 patients (86%) who received the drug (one required digoxin, one required synchronized cardioversion). Vagal maneuvers are safe in young, otherwise healthy patients but problems have been documented in the literature in older patients, who have a higher likelihood of coronary and/or cerebrovascular disease. Clinical decision analysis indicates that young patients should be treated initially with vagal maneuvers but that older patients (above approximately 65 years of age) should be treated initially with verapamil.
-
Fourteen patients with either acute myocardial infarction or unstable angina pectoris were transported by helicopter air ambulance to North Carolina Baptist Hospital during a 1-month period. Six patients had preflight and inflight plasma epinephrine and norepinephrine levels determined. All 14 patients were monitored for ventricular arrhythmias. ⋯ No patient had a monitored ventricular arrhythmia. These findings suggest that helicopter transport of cardiac patients may be associated with significant patient stress, as reflected by high inflight catecholamine levels. Further study with a larger population of patients is needed to determine whether or not an increased incidence of inflight ventricular arrhythmias is associated with these catecholamine changes.
-
Prehospital patient management decisions are complex because the traumatized patient population is heterogeneous with respect to demographics, mechanism of injury, physiological response to injury, and time from injury to medical care. One hundred and nine blunt trauma patient evaluations by paramedics in a county-wide semirural emergency medical services (EMS) system were analyzed to determine paramedic time on the scene and the factors that might influence onscene time. Onscene time linearly correlated with a prolonged transport time. ⋯ However, patient groups with either a low TS or a low GCS score showed no significant improvement in TS with increasing onscene time. Without a strict management algorithm, paramedics use a variety of cues to guide their actions during the onscene management of blunt trauma. Future studies should address the impact of strict management algorithms on onscene time and ultimate patient outcome.
-
The helicopter transport of acute cardiac patients has become increasingly common, although no study has examined solely the effect of such transport on outcome in this subset of patients. A combined air and ground critical care transport service provided the opportunity for a direct comparison of patients with acute cardiac conditions (myocardial infarction or unstable angina) transported either by our helicopter or by a specially equipped critical care ground vehicle. Both air and ground components were similarly equipped in terms of personnel and medical equipment. ⋯ Serious untoward events, defined as arrhythmias, chest pain, hypotension, bradycardia, seizures, and cardiac arrest, occurred in 41% of air transports and 7.5% of ground transports (P less than .002). The overall incidence of untoward events was also significantly greater with air transports (25/51, or 49%) than with the ground vehicle (4/27, or 15%; P less than .005). The reasons for these differences are unknown.